Should I become a medical scribe? A guide for pre-PA and pre-med students

May 15 / Deborah Gutman
Should I become a scribe is one of the most common questions I get asked about clinical experience.

Where did this whole “scribe” thing even come from and what is it about? Will it help me improve my candidacy for medical school or PA school? How do I find a scribe job and then figure out if it is the right fit? Let’s talk.

Here is what you need to know:

Scribes are an entry level job that grew directly out of the increased use of electronic health records (EHR) and their increased administrative burden, as well as, the barrier that EHR created between physicians and patients in the exam room. The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 – yes, that is a lot of acronyms and words- but what it meant was the federal government required a transition to EHRs to avoid penalties and receive certain incentives. In 2014 it became mandatory for all clinical practices to use electronic health records. The end result – an increased demand for data entry and documentation requirements and a growth in medical scribes.

As an emergency physician I am very familiar with the idea of medical scribes since their popularity primarily grew in emergency departments across the country due to the high volume and rapid pace of patient care in our clinical setting that makes documentation increasingly challenging. In 2016 it was estimated that there were 20,000 scribes working in hospitals and medical practices, which was projected to grow to 100,000 scribes by 2020, making medical scribing one of the fastest growing entry level healthcare jobs.
What will you be doing if you decide to be a medical scribe?

A medical scribe is a professional who works closely with healthcare providers to assist with documentation and administrative tasks. The primary responsibility of a medical scribe is to accurately and efficiently record patient encounters, medical histories, physical examinations, and treatment plans in electronic health records (EHRs). By documenting patient information in real-time, medical scribes enable healthcare providers to focus more on patient care during appointments. So essentially, typing the note into the chart and helping the clinician stay organized administratively. 

Some common tasks performed by medical scribes include:

  • Documenting patient encounters and medical information in EHRs.
  • Assisting healthcare providers with data entry and paperwork.
  • Updating patient charts, including lab results and medication lists.
  • Transcribing dictations or physician’s notes.
  • Organizing and maintaining patient records.
  • Coordinating communication between healthcare providers and other medical staff.
  • Managing administrative duties like scheduling appointments and handling phone calls and placing referrals to other settings.

In practice what that looks like is that you are assigned to either one or several clinicians at a practice and you will get your “computer on wheels” or ipad and follow the clinicians into patient rooms in real time as they talk to and care for patients. You are technically a “fly on the wall” and are not expected, and in some cases discouraged, from talking to patients directly. The purpose of the scribe came out of a need for clinicians to remove the EHR as a communication barrier between them and the patient.

Scribe America describes it as shadowing but “ You get to work with the electronic health record and get paid.” Scribes do not touch patients, handle body fluids, provide medical advice or interpretation.

Scribing will occasionally present you with some leadership opportunities if you stay long enough. You might be promoted to chief scribe or scheduler, get an opportunity to train other scribes, or become an ambassador for the practice or scribe company.

Medical scribes can work with a diverse range of patient populations, it is all dependent on the healthcare setting they are employed in. They may assist physicians, nurse practitioners, or other healthcare providers who specialize in various fields, such as primary care, internal medicine, pediatrics, cardiology, or emergency medicine. The patient population can vary in terms of age, medical conditions, and healthcare needs and geography. You might be working in a hospital, clinic, outpatient center, specialty practice, or an emergency department. They may work in both urban and rural areas, supporting healthcare providers across different specialties. The specific practice setting can influence the nature of the work and the types of patients encountered.

Certification Process:

 While there is no universal certification requirement for medical scribes, some organizations and employers may prefer or require certification as a way to demonstrate proficiency in the role. The American College of Medical Scribe Specialists (ACMSS) offers the Certified Medical Scribe Specialist (CMSS) certification, which requires passing an exam covering medical terminology, healthcare documentation, and EHR proficiency. The exam is designed to evaluate the knowledge and skills necessary to be an effective medical scribe. Additionally, there are online training programs and courses available that can provide education and prepare individuals for the role of a medical scribe.
I would probably hold off on taking a private certification course or exam until you know what job you will be securing since many companies and even individual practices will train you on the job and provide their own internal training to help you learn their specific medical record, patient flow, and billing requirements. Your training shifts might be paid or unpaid. Training might take between 4-6 weeks.
So before you go crazy turning yourself into a professional scribe – look at the available jobs in the geographic area you are hoping to work in and find out what their job requirements are and if they integrate their own training, also look into which EHR is being used at those clinical sites.

Once you’ve done that, here are some things you can think about to help position yourself to get the job:
  • Take a medical terminology course at school or online
  • Take a billing/coding primer online
  • Become a good typer! > 70+ words/minute (some will test you to be sure you can do at least 40 words/minute) You can test your typing speed here.
  • Be someone with outstanding attention to detail, the ability to multitask and to work under pressure in a fast paced environment.
  • Familiarize yourself with common EHR platforms such as EPIC. Many larger EHR companies have what they call a “sandbox” where you can learn and play with the technology without directly affecting patient care. Typically you would need to be working for a company already using that technology to get access. If you are in a clinical research position you might have access through the affiliated hospital. You can go to google and type in the name of the EHR and then add “online training” to see if you can find a free or low cost course. The most commonly used EHR systems include: EPIC, Cerner, Meditech, Evident, and AllScripts. I found the following training available online for free: 
           o EPIC videos can be found here. They are a bit dated (2017) from their original go live, but can give you a good overview. 
           o Cerner has their own YouTube channel with training videos.
           o Meditech also has their own online training videos.
           o There are many organizations that offer EHR-related certifications and credentials, such as the American Health                                   Information Management Association (AHIMA), the Healthcare Information and Management Systems Society (HIMSS),                     and the American Medical Informatics Association (AMIA). However, these are targeted towards employees looking for a                   long term career in EHR informatics.

If you do these things – make sure you mention them in your cover letter and resume!!

Where can you find a scribe job? Almost anywhere.
  • Hospitals or healthcare systems: Many hospitals have their own homegrown programs (like my previous employer at Lifespan hospital) or OHSU; Oak Street Health Scribe Program that employs 100 scribes in 20 states; To find these jobs look at the hospitals in the area you want to work and go to their job portal and search for “scribe”
  • National Scribe Companies: There are national companies that contract out to hospitals, EDs and ambulatory practices. The larger companies include: Scribe America, ProScribe
  • Physician Practices or Groups: There are individual and group private practices that train and hire their own scribes. People tend to find these by word of mouth or even by volunteering themselves as a scribe to physicians or practices they know. Use your network to see if someone is hiring, your pre health office may also be listing these local opportunities online or sending them out in a monthly newsletter. I’ve even had students go door knocking in their local neighborhood to local practices to see if they are hiring.

What are the pros/cons of working as a scribe for a pre-PA or pre-med student?
Scribe jobs have a very low bar for hiring, generally you need to be a high school student with typing skills. The other training is typically once you are hired. There is no required certification. These jobs are also readily available in multiple geographic locations.

As a scribe you will get direct 1:1 access to clinicians – PAs, physicians, nurse practitioners. This is by far the biggest benefit of scribing – professional identity formation/shadowing. Although while you are on shift you don’t want to distract them by picking their brain about their careers, you will have a front seat to clinician-patient communication skills and depending on your clinician they will bring you into their decision making in order to help you chart for them.

You will learn about the structure of a medical encounter (History of present illness, review of systems, physical exam, medical decision making, assessment and plan), and the importance of records accuracy for communication between providers and with billing companies.

Another pro is that the work can be flexible – both part time and full time and varying shift work (days, evenings, or nights), so scribing is something you could potentially balance with your undergraduate years.

The cons are that it is not a patient care position (if all you are doing is scribing). You typically will not interact with patients but rather, watch someone else interact with patients. You do not provide any direct patient care so will not have the opportunity to work on some of those more patient facing competencies and interpersonal communication skills. On that note; Some medical schools and PA schools do not consider this patient care experience because of this. This is a bigger issue for PA school applicants because PA schools have strict guidelines around what they consider Patient Care Experiences (PCE). I would advise that before you take a scribe job that you go directly to the websites of the PA schools you are interested in and look at their lists of approved PCE experiences.

Another thing I’ve heard from students who scribe is that there is a steep learning curve initially but it can become very rote (and maybe boring) after awhile (over one year), unless you take on additional responsibilities.

A more existential “con” is that these jobs may not be around in a few years as more virtual scribe and AI scribe programs come onto the market, for example, DeepAI 

Now that I know what a scribe does and it seems like lots of people are hiring scribes, how do I evaluate my job options

You want the job that will give you the most experience. You can choose to aim for a long term relationship with a single physician where the benefit would be a longitudinal relationship where you get to know their particular work style and then ultimately get a strong letter from that single clinician. On the other hand you may want a clinical site with a variety of clinicians so you get a broad perspective on different workstyles or even patient populations. Either one is valuable.

With that being said I would avoid any “virtual scribe” positions. At that point you are not even in the healthcare setting but are scribing from home – you may still learn about clinician patient interactions but are missing significant nuances about the healthcare system and team by not being present in the room.

Figure out exactly who you are working for. If you will be working for a large company and contracted out to different sites the advantage is you might get exposed to different types of specialties and a variety of clinicians and practice types and have less control over where you end up. You may not be able to specify exactly what specialty you want to work with.

If you work directly for a practice you will get the advantage of choosing a specialty that might be of high interest to you, and it may be a more stable, established relationship with a single or small group of clinicians. You are also more likely to benefit from group camaraderie like company outings or holiday gifts since you are directly employed by the practice.

Is it a scribe (+) job? Read the job description carefully. It may be under “scribe” but may incorporate more responsibilities than just scribing. Will you get graduated responsibilities once you’ve begun working there? Some private practices will hire you as a scribe but train you on other administrative and patient care tasks the longer you stay with the practice. I’ve had scribes transition to full medical assistant roles over time within my own clinical practice. This is more likely to happen in a private or small group practice where they get to know you and have a smaller, leaner operating staff. For example, one current listing with an ophthalmology practice states that the scribe will perform basic ocular screening and take initial patient history which is more than what a scribe book typically does.

Remember to look for leadership, graduated responsibility, or additional shadowing opportunities.

What is the expected hourly wage?

On average you could make $17.25/hour

Things that can impact your salary include prior experience, whether you are working directly for a practice vs. working for a larger contracting company, the region you live in, the specialty and the expected additional tasks

You will have part time or full time opportunities, and possibly remote opportunities (although I would highly discourage this).

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